Fallopian Tube Mucosal Involvement in Cervical Gastric-type Adenocarcinomas

Abstract

Cervical gastric-type adenocarcinomas are aggressive non-human papillomavirus-related carcinomas with a propensity for extracervical spread, including unusual sites such as the omentum, peritoneum, and ovary. We report 7 cases of cervical gastric-type adenocarcinoma with fallopian tube involvement predominantly in the form of mucosal colonization without underlying invasion. As far as we are aware, this has not been previously described and this report adds to the literature regarding metastatic neoplasms, which may exhibit tubal mucosal involvement and mimic an in situ lesion at this site. In all cases, there was associated ovarian involvement and in 6 of 7 cases, there was endometrial colonization. We speculate that the fallopian tube (and ovarian) involvement is secondary to transuterine spread. Given the occasional occurrence of multifocal gastric-type glandular lesions (benign or malignant) involving different sites in the female genital tract, we discuss the distinction between synchronous independent and metastatic lesions.

Pelvic and Ovarian Recurrence of Small HPV-associated Cervical Adenocarcinoma With Transformation to Neuroendocrine Carcinoma

“…Alternatively it is possible that endometrial and tubal involvement could be present in some cases but not picked up by limited sampling of these tissues. A similar phenomenon of adnexal (ovarian and tubal) involvement secondary to transuterine spread has also been reported in gastric-type cervical adenocarcinoma (an HPV-independent cervical adenocarcinoma) (11). In our case, there was upward contiguous spread of AIS involving the lower uterine segment and endometrium.…”

Ovarian Metastasis by Gastric-type Endocervical Adenocarcinoma: A Clinicopathologic Description of 12 Cases

“…Several reports have described the morphologic features of tumors, mostly HPV-related adenocarcinomas, that fall into this category (4-6). Little attention has been paid to ovarian metastases from adenocarcinomas of gastric-type, the major histotype of non-HPV-related adenocarcinomas (10). The current study describes 12 cervical gastrictype adenocarcinomas metastatic to the ovary.…”

“…The clinical outcomes have been reported to be favorable in patients with endocervical adenocarcinomas with isolated ovarian involvement (6,20), however, this has not been substantiated in gastric-type adenocarcinoma. To date, only 1 investigation has specifically discussed the fallopian tube involvement in the spread of gastrictype adenocarcinoma to the ovary (10). In that report, 7 gastric-type endocervical adenocarcinomas had concurrent ovarian and fallopian tube mucosal spread, 6 of which also involved the endometrium; therefore, the authors suggested that retrograde uterine spread might be the likely mode of ovarian involvement in gastric-type adenocarcinomas.…”

“…Gastric-type adenocarcinoma, a rare subtype of cervical adenocarcinoma, is not associated with high-risk human papillomavirus (HPV), but it has a propensity for ovarian and peritoneal metastasis, thereby demonstrating a more aggressive clinical behavior than the usual HPV-associated cervical adenocarcinoma 7–9. However, the clinicopathologic features of ovarian metastasis in gastric-type adenocarcinoma have not been well documented until recently 10. In the present study, we report a large case series of cervical gastric-type adenocarcinomas with ovarian metastases from a single institution and describe the clinicopathologic findings, as well as postulate on the possible routes of spread.…”

Endocervical Adenocarcinoma, Gross Examination, and Processing, Including Intraoperative Evaluation: Recommendations From the International Society of Gynecological Pathologists

“…If salpingectomy and/or oophorectomy were performed, these organs should be sliced using the sectioning and extensive examination of the fimbriae (SEE-Fim) protocol to evaluate for metastasis, which may occur, albeit uncommonly 39 – 41 , 50 . There is no clear evidence to guide whether grossly normal appearing ovaries and fallopian tubes should be microscopically examined in their entirety in this setting.…”